Takahashi Akira, Sugawara Chieko, Kudoh Keiko, Yamamura Yoshiko, Ohe Go, Tamatani Tetsuya, Miyamoto Youji
1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
2 Department of Oral Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan.
Dentomaxillofac Radiol. 2018 Jan;47(1):20170251. doi: 10.1259/dmfr.20170251. Epub 2017 Oct 27.
Lingual tonsilloliths are not as well-known to radiologists than palatine tonsilloliths, although they might be common in clinical practice. The aim of this investigation was to clarify the prevalence and imaging characteristics of lingual tonsilloliths using panoramic radiographs and CT images.
This study included 2244 patients without pathology at the base of tongue who had undergone panoramic radiography and CT of the maxillofacial region. The size, number and position of lingual tonsilloliths relative to the mandible and tongue were evaluated.
Lingual tonsilloliths were observed in 33 (1.5%) and 108 (4.8%) of all patients on panoramic radiographs and CT images, respectively. The prevalence was higher in patients aged ≥40 years than in those aged < 40 years (χ, p < 0.01). They appeared as small, round- or rod-shaped calcified bodies, and they always located closely anterior (1-17 mm) to the anterior border of oropharyngeal airway on panoramic radiographs. Lingual tonsilloliths were superimposed over the surrounding soft tissue inferior to the body of the mandible, posteroinferior to the angle of the mandible and posterior to the mandible in 16 (48.5%), 15 (45.5%) and 1 (3.0%) individual, respectively. A significant correlation was observed between the detectability on panoramic radiographs and size (Spearman's r = 0.961, p < 0.01) of tonsilloliths, as revealed by CT images.
Lingual tonsilloliths commonly appear on CT. They also appear on panoramic radiography and may superimpose the surrounding soft tissue of the mandible. Although lingual tonsilloliths may resemble other pathological calcifications including submandibular sialoliths and lingual osseous cholistoma, they can be differentiated by carefully observing panoramic radiographs. When clinicians detect calcified bodies near the base of tongue, lingual tonsilloliths should be included in the differential diagnoses.
尽管舌扁桃体结石在临床实践中可能很常见，但放射科医生对其的了解不如腭扁桃体结石。本研究的目的是利用全景X线片和CT图像阐明舌扁桃体结石的患病率及影像特征。
本研究纳入了2244例舌根部无病变且接受过颌面区域全景X线摄影和CT检查的患者。评估了舌扁桃体结石相对于下颌骨和舌头的大小、数量及位置。
在所有患者中，全景X线片和CT图像上分别有33例（1.5%）和108例（4.8%）观察到舌扁桃体结石。年龄≥40岁患者的患病率高于年龄<40岁的患者（χ²，p<0.01）。它们表现为小的圆形或棒状钙化体，在全景X线片上总是位于口咽气道前缘前方很近的位置（1 - 17mm）。舌扁桃体结石分别在16例（48.5%）、15例（45.5%）和1例（3.0%）个体中叠加在下颌骨体下方的周围软组织、下颌角后下方及下颌骨后方。CT图像显示，全景X线片上结石的可检测性与结石大小之间存在显著相关性（Spearman秩相关系数r = 0.961，p<0.01）。
舌扁桃体结石在CT上常见。它们也可出现在全景X线片上，并可能叠加在下颌骨周围软组织上。尽管舌扁桃体结石可能类似于其他病理性钙化，包括下颌下涎石和舌骨化性胆脂瘤，但通过仔细观察全景X线片可进行鉴别。当临床医生在舌根部附近检测到钙化体时，舌扁桃体结石应纳入鉴别诊断。
